Comparative Efficacy of Conservative Medical
and Chiropractic Treatments for Carpal Tunnel
Syndrome: A Randomized Clinical Trial

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   J Manipulative Physiol Ther 1998 (Jun); 21 (5): 317–326

Davis PT, Hulbert JR, Kassak KM, Meyer JJ

Northwestern College of Chiropractic,
Bloomington, MN 55431, USA

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This study sought to compare the effects of chiropractic care and conventional medical care for managing carpal tunnel syndrome. 91 patients with confirmed symptoms of carpal tunnel syndrome were divided into two groups. One group received decreasing amounts of ibuprofen over three weeks. The other group received manipulation of bony joints and soft tissues of the upper extremities and spine. The patients’ improvement was monitored through self-reports and analyses of the vibrometric sensibility of the hands. There was improvement in comfort, finger sensation and nerve conduction in both groups. For right hands affected by carpal tunnel the group who received medical care improved by 1.37 decibels according to the vibrometric tests. Those receiving chiropractic care improved by 3.05 decibels. Davis et al. compared chiropractic treatment of carpal tunnel syndrome (CTS) to nonsurgical medical treatment. The chiropractic group used manipulation, ultrasound, and wrist supports while the medical group used wrist supports and ibuprofen. While both treatment groups improved significantly, the authors noted that chiropractic represents an alternative conservative treatment for CTS, especially for patients "who are unable to tolerate ibuprofen"

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OBJECTIVE:   To compare the efficacy of conservative medical care with chiropractic care in the treatment of carpal tunnel syndrome.

DESIGN:   Two-group, randomized, single-blind trial with 9 wk of treatment and a 1-month follow-up interview.

  SETTING: Wolfe-Harris Center for Clinical Studies at Northwestern College of Chiropractic in Bloomington, Minnesota.

PATIENTS:   Ninety-one of 96 eligible subjects who reported symptoms that were confirmed by clinical exam and nerve conduction studies.

INTERVENTIONS:   Interventions included ibuprofen (800 mg 3 times a day for 1 wk, 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk) and nocturnal wrist supports for medical treatment. Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine (three treatments/week for 2 wk, two treatments/week for 3 wk and one treatment/week for 4 wk), ultrasound over the carpal tunnel and nocturnal wrist supports.

MAIN OUTCOME MEASURES:   Outcome measures were pre- and postassessments of self-reported physical and mental distress, nerve conduction studies and vibrometry. RESULTS: There was significant improvement in perceived comfort and function, nerve conduction and finger sensation overall, but no significant differences between groups in the efficacy of either treatment.

CONCLUSION:   Carpal tunnel syndrome associated with median nerve demyelination but not axonal degeneration may be treated with commonly used components of conservative medical or chiropractic care.

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